Householder Application for Planning Permission for works or extension to a dwelling. Town and Country Planning Act 1990

NP/K/01091008

Publication of applications on planning authority websites Please note that the information provided on this application form and in supporting documents may be published on the Authority's website. If you require any further clarification, please contact the Authority's planning department.

Please complete using block capitals and black ink. It is important that you read the accompanying guidance notes as incorrect completion will delay the processing of your application.

| 1. Applicant Name and Address | 2. Agent Name and Address | |-------------------------------|---------------------------| | Title: | Mr. | | First name: | Andrew | | Last name: | Smith | | Company (optional): | Valley Properties | | Unit: | House number: | | House number: | 7 | | House suffix: | | | House name: | Newbridge Cottage | | Address 1: | Newbridge Road | | Address 2: | Meltham | | Address 3: | | | Town: | Holmfirth | | County: | Yorkshire | | Country: | England | | Postcode: | HD9 4AA |

3. Description of Proposed Works Please describe the proposed works:

PROPOSED SINGLE STOREY EXTENSION TO WEST ELEVATION. 3. Description of Proposed Works (continued)

Has the work already started? □ Yes □ No If Yes, please state when the work was started (DD/MM/YYYY):

Has the work already been completed? □ Yes □ No If Yes, please state when the work was completed (DD/MM/YYYY):

4. Site Address Details

Please provide the full postal address of the application site.

Unit:\
House number:\
House suffix:

House name: NEWBRIDGE COTTAGE Address 1: NEWBRIDGE ROAD Address 2: MELTHAM Address 3:\
Town: HOLMFIRTH County: YORKSHIRE Postcode (optional): HD9 5TE

5. Pedestrian and Vehicle Access, Roads and Rights of Way

Is a new or altered vehicle access proposed to or from the public highway? □ Yes □ No Is a new or altered pedestrian access proposed to or from the public highway? □ Yes □ No Do the proposals require any diversions, extinguishments and/or creation of public rights of way? □ Yes □ No

If Yes to any questions, please show details on your plans or drawings and state the reference number(s) of the plan(s)/drawing(s):

6. Pre-application Advice

Has assistance or prior advice been sought from the local authority about this application? □ Yes □ No If Yes, please complete the following information about the advice you were given. (This will help the authority to deal with this application more efficiently). Please tick if the full contact details are not known, and then complete as much possible:

Officer name: KEVIN WELDON Reference:

Date (DD/MM/YYYY): NOV 2008 Details of the pre-application advice received:

APPLY FOR SINGLE STOREY LEAN TO STRUCTURE

7. Trees and Hedges

Are there any trees or hedges on your own property or on adjoining properties which are within falling distance of your boundary? □ Yes □ No If Yes, please mark their position on a scaled plan and state the reference number of any plans or drawings:

Will any trees or hedges need to be removed or pruned in order to carry out your proposal? □ Yes □ No If Yes, please show on your plans which trees by giving them numbers e.g. T1, T2 etc. state the reference number of the plan(s)/drawing(s) and indicate the scale:

8. Parking

Will the proposed works affect existing car parking arrangements? □ Yes □ No If Yes, please describe:

9. Authority Employee / Member

With respect to the Authority, I am: (a) a member of staff □ Yes □ No (b) an elected member □ Yes □ No (c) related to a member of staff □ Yes □ No (d) related to an elected member □ Yes □ No If yes please provide details of the name, relationship and role

### 10. Materials

If applicable, please state what materials are to be used externally. Include type, colour and name for each material:

| | Existing (where applicable) | Proposed | Not applicable | Don't know | |----------------|-----------------------------|----------|----------------|------------| | Walls | **NATURAL LOCAL COURSED STONE** | **NATURAL LOCAL COURSED STONE** | | | | Roof | **STONE SLATES** | **RECLAIMED SECOND HAND STONE SLATES** | | | | Windows | **TIMBER** | **TIMBER** | | | | Doors | **TIMBER** | **TIMBER** | | | | Boundary treatments (e.g. fences, walls) | | | ✓ | | | Vehicle access and hard-standing | | | ✓ | | | Lighting | | | | | | Others (please specify) | | | ✓ | |

Are you supplying additional information on submitted plan(s)/drawing(s)/design and access statement?\
☑ Yes ☐ No

If Yes, please state references for the plan(s)/drawing(s)/design and access statement:

09 | 056 | 01 | 03 11. Ownership Certificates

One Certificate A, B, C, or D, must be completed, together with the Agricultural Holdings Certificate with this application.

CERTIFICATE OF OWNERSHIP - CERTIFICATE A

Town and Country Planning (General Development Procedure) Order 1994 Certificate under Article 1

I certify that the applicant certifies that on the day 21 days before the date of this application nobody except myself/the applicant was the owner (owner is a person with a freehold interest or leasehold interest with at least 7 years left to run of any part of the land or building on which the application relates).

Signed - Applicant: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Original - Agent: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date (DD/MM/YYYY): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CERTIFICATE OF OWNERSHIP - CERTIFICATE B

Town and Country Planning (General Development Procedure) Order 1994 Certificate under Article 1

I certify that the applicant certifies that on the day 21 days before the date of this application, was the owner (owner is a person with a freehold interest or leasehold interest with at least 7 years left to run of any part of the land or building on which this application relates).

Name of Owner: FRANK ORLINSKI

Address: GRIMLES BARN NEW BRIDGE ROAD

Signed - Applicant: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Original - Agent: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date (DD/MM/YYYY): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CERTIFICATE OF OWNERSHIP - CERTIFICATE C

Town and Country Planning (General Development Procedure) Order 1994 Certificate under Article 1

I certify that the applicant certifies that:

- Neither Certificate A or B can be issued for this application.
- All reasonable steps have been taken to find out the names and addresses of the other owners (owner is a person with a freehold interest or leasehold interest with at least 7 years left to run of the land or building, or of a part of it, but I have been unable to do so.

The steps taken were:

Name of Owner: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date (DD/MM/YYYY): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Notice of this application has been published in the following newspaper (specifying the newspaper where the land is situated):

Signed - Applicant: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Original - Agent: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date (DD/MM/YYYY): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 11. Ownership Certificates (continued)

CERTIFICATE OF OWNERSHIP - CERTIFICATED

Town and Country Planning (General Development Procedure) Order 1995 Certificate under Article 7

I certify that the applicant certifies that:

- Certificate A cannot be issued for this application
- All reasonable steps have been taken to find out the names and addresses of everyone else who, on the day 21 days before the date of this application, was the owner (owing to a person with a freehold interest or leasehold interest with at least 7 years left to run) of any part of the land to which this application relates, but I have/ the applicant has been unable to do so.

The steps taken were:

Notice of the application has been published in the following newspaper (circulating in the area where the land is situated):

On the following date (which must not be earlier than 21 days before the date of the application):

Signed - Applicant: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Or signed - Agent: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date (DD/MM/YYYY): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

12. Agricultural Holdings

AGRICULTURAL HOLDINGS CERTIFICATE

Town and Country Planning (General Development Procedure) Order 1995 Certificate under Article 7

Agricultural Land Declaration - You Must Complete Either A or B

(A) None of the land to which the application relates is, or is part of, an agricultural holding.

Signed - Applicant: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Or signed - Agent: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date (DD/MM/YYYY): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(B) I have/ The applicant has given the requisite notice to every person other than myself/ the applicant who, on the day 21 days before the date of this application, was a tenant of an agricultural holding on all or part of the land to which this application relates, as listed below:

| Name of Tenant | Address | Date Notice Given | |----------------|---------|-------------------|

Signed - Applicant: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Or signed - Agent: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date (DD/MM/YYYY): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

13. Planning Application Requirements - Checklist

Please read the following checklist to make sure you have sent all the information in support of your proposal. Failure to submit all information required will result in your application being deemed invalid. It will not be considered valid until all information required by the Local Planning Authority has been submitted.

The original and 3 copies of a completed and dated application form: ☑

The original and 3 copies of a plan which identifies the land to which the application relates drawn to an identified scale and showing the direction of North: ☑

The original and 3 copies of other plans and drawings or information necessary to describe the subject of the application: ☑

The original and 3 copies of a design and access statement where proposed works fall within one of the following designated areas:

- National Park
- Site of special scientific interest
- Conservation area
- Area of outstanding natural beauty
- World Heritage Site
- The Broads

The correct fees: ☑

The original and 3 copies of the completed, dated Ownership Certificate (A, B, C or D) - as applicable: ☑

The original and 3 copies of the completed, dated Agricultural Holdings Certificate (Agricultural Holdings): ☑ 14. Declaration

We hereby apply for planning permission/consent as described in this form and the accompanying plans/drawings and additional information.

Signed - Applicant: [Signature] Or signed - Agent: [Signature] Date (DD/MM/YYYY): 21/11/09 (date cannot be pre-application)

15. Applicant Contact Details

| Telephone numbers | Extension number: | |-------------------|------------------| | Country code: | National number: | | | Extension number: | | Country code: | Mobile number (optional): | | | Extension number: | | Country code: | Fax number (optional): | | | Extension number: |

Email address (optional):

16. Agent Contact Details

| Telephone numbers | Extension number: | |-------------------|------------------| | Country code: | National number: | | | Extension number: | | Country code: | Mobile number (optional): | | | Extension number: | | Country code: | Fax number (optional): | | | Extension number: |

Email address (optional):

17. Site Visit

Can the site be seen from a public road, public footpath, bridleway or other public land?\
☐ Yes ☐ No

If the planning authority needs to make an appointment to carry out a site visit, whom should they contact? (Please select only one)

☐ Agent ☐ Applicant ☐ Other (if different from the agent/applicant's details)

If Other has been selected, please provide:

Contact name: [Name] Telephone number: [Number] Email address: [Email]